Provider Demographics
NPI:1053072645
Name:KASH, LAUREL RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:RENEE
Last Name:KASH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURIE
Other - Middle Name:RENEE
Other - Last Name:KASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:677 S LOWELL ST APT S664
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4816
Mailing Address - Country:US
Mailing Address - Phone:503-997-8296
Mailing Address - Fax:
Practice Address - Street 1:677 S LOWELL ST APT S664
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4816
Practice Address - Country:US
Practice Address - Phone:503-997-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8372153104A0630X, 174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR837215OtherEXPRS MEDICAID PROVIDER NUMBER